The proposed study will examine the relationship between self-perceived health status and all-cause and cause-specific mortality in a cohort\ (N=1, 224) of paper manufacturing workers (ages 35-69 at intake) followed for 22 years. It is hypothesized that there will be a positive association between the number of symptoms reported at intake and subsequent mortality. Symptom reports will be measured by the Cornell Medical Index (CMI). The date and cause of death will be ascertained by securing death certificates from Vital Statistics Offices in North Carolina and the surrounding states in the Southeast. The company personnel office and or the Social Security Administration will be used to ascertain vital status and the last known address. After the information on the death certificates is nosologized and keyed, it will be linked with existing automated files in the Department of Epidemiology at the University of North Carolina. These files contain CMI responses, coded occupational titles, and risk factor information collected at intake. The data analysis will be based upon conventional (stratum-specific and standardized) mortality rates, and upon parametric and nonparametric survival techniques with covariables. Supplementary analyses could compare the mortality experience of the paper manufacturing cohort with the mortality experience of the general population (national, state, and multiple-county level data).